What is the preferred anxiolytic (anti-anxiety) medication for lactating (breastfeeding) women?

From the Guidelines

For breastfeeding women with anxiety, sertraline (Zoloft) is the preferred first-line medication option due to its minimal transfer into breast milk and extensive safety profile for infants. When considering anxiolytic medications for lactating women, it's crucial to weigh the benefits of treating maternal anxiety against the potential risks to the infant. According to 1, sertraline is a preferred choice because it provides the infant with less than 10% of the maternal daily dose (normalized for weight), and its ratio of infant to maternal plasma concentrations is relatively low. Some key points to consider when prescribing anxiolytics to breastfeeding women include:

• The medication's transfer into breast milk and its potential impact on the infant
• The likelihood of adverse effects, such as diminished suck, sleep disturbances, or decreased growth
• The importance of monitoring the infant for unusual drowsiness, feeding difficulties, or irritability when starting any medication
• The benefits of treating maternal anxiety, which can negatively impact both maternal wellbeing and mother-infant bonding if left untreated Other relatively safe options, as mentioned in 1, include paroxetine (Paxil) and fluvoxamine (Luvox), which are also minimally excreted in human milk. However, sertraline remains the most recommended choice due to its well-established safety profile and minimal risk to infants. In terms of dosage, sertraline can be started at 25-50mg daily and gradually increased to 50-200mg daily as needed, while low-dose lorazepam (Ativan) at 0.5-1mg as needed may be used sparingly for short-term anxiety relief, though regular use should be avoided due to potential sedation effects in infants. Ultimately, treatment decisions should always be made in consultation with healthcare providers who can assess individual circumstances and risks, as emphasized in 1.

From the FDA Drug Label

Nursing MothersBecause Prozac is excreted in human milk, nursing while on Prozac is not recommended. The FDA drug label does not answer the question.

From the Research

Anxiolytic Medications for Lactating Women

• The preferred anxiolytic medication for lactating women is not explicitly stated in the provided studies, as they primarily focus on antidepressants. However, some studies mention the safety of certain medications during breastfeeding 2, 3, 4, 5.
• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are considered relatively safe to use during breastfeeding, with low levels present in breast milk 5.
• Sertraline is often recommended as a preferred agent due to its low concentration in breast milk and lack of association with infant complications 2, 4, 5, 6.
• Other antidepressants, such as tricyclics (e.g., amitriptyline, nortriptyline), are also considered safe for use during breastfeeding, but the decision to use them should be made on a case-by-case basis, considering the potential risks and benefits 4.
• Monoamine oxidase inhibitors (MAOIs) should generally be avoided during breastfeeding due to limited safety data 5.

Key Considerations

• When prescribing anxiolytic or antidepressant medication to a lactating woman, the provider should consider the individual's specific needs and circumstances, weighing the potential benefits against the potential risks to the infant 2, 3, 5.
• The decision to use a particular medication should be made in conjunction with the patient, taking into account factors such as the medication's side effect profile, relative infant dose, and the woman's overall health and well-being 5.
• Further research is needed to fully understand the safety and efficacy of various medications during lactation, particularly for newer agents or those with limited data available 4, 6.